- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $4,265.80 / $9,549.93
| Facility | | $131.83 | $4,265.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $177.83 / $707.95
| Professional | | $123.03 | $177.83 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $2,691.53 / $4,265.80
| Facility | | $1.00 | $2,691.53 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $0.02 / $0.02 / $0.02
| Facility | 50 | $0.02 | $0.02 | $0.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $302.00 / $489.78
| Professional | | $204.17 | $302.00 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $467.74 / $1,122.02
| Facility | | $331.13 | $467.74 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $23.44 / $23.44 / $23.44
| Facility | AS | $23.44 | $23.44 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $398.11 / $602.56
| Professional | | $263.03 | $398.11 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $446.68 / $870.96
| Facility | | $363.08 | $446.68 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $338.84 / $501.19
| Professional | | $239.88 | $338.84 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.76 / $707.95 / $5,495.41
| Facility | | $0.76 | $707.95 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,570.88 / $4,570.88 / $4,570.88
| Facility | 50 | $4,570.88 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $316.23 / $831.76
| Professional | | $173.78 | $316.23 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,862.09 / $3,715.35
| Facility | | $1,096.48 | $1,862.09 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $275.42 / $524.81
| Professional | | $169.82 | $275.42 | $524.81 |